End of the Road -- Cedar Rapids, Iowa --Day2

Much of what we heard echoed findings in CT and TX. One thing stands out – the number of self insured. Among the folks we spoke to in Iowa, easily 60% were self insured or had policies with their place of employment where their contribution was $800 to $1200 per month -- smaller employers, less need and ability to compete for employees based on the value of the benefits package. It is easy to begin to think that the country is like the NY metro or LA – it’s not. Life is different in the heartland. Cost of healthcare is a critical concern here.

Not surprisingly the Iowans we met with supported revamping the healthcare system – they strongly felt the need for a system that would provide access to all. The nature of this system is unclear, but one thing is certain they do not what they describe as “socialized” medicine. Once again they desire a unique American solution that may borrow from the best practices of other nations, but would maintain some element of individual pay for service – though this was seen as being heavily subsidized. As opposed to health care being a right the analogy with fire services kept on coming up in Iowa. Like fire departments, health care was seen as something all citizens should support for the public good. It is seen as a public service that all agree to support as opposed to a “socialist” system imposed on them.

There are several barriers that exist, however, in pursuing this vision. Some of theses, undoubtedly, have been foisted on the public by the healthcare industry. Concerns that emerged on a regular basis –

America has the most advanced health technology in the world – a national system would thwart further research and development.

Any national effort to control drug prices would result in pharmaceutical companies cutting back on research and development.

A national system that regulated costs may result in a decline in the quality of services.
I would not be able choose my doctor.

Care would be relegated to public clinics.

May have to wait days or weeks to see a doctor.

Costs will continue to escalate resulting in higher and higher taxes.

Iowa Day 1 -- Tornado Evacuation

Last night was a first. About half way through the first group sirens started blaring, windows were rattling, and the building shook – Tornado. I had no idea what was going on and just kept plugging along until one of the supervisors at the facility told us we would have to evacuate to a secure room. About half an hour passed, the storm blew over, and we resumed.

As has been the case in all of the sessions so far the biggest concern was cost. Quite a few of our respondents were self insured, many with catastrophic policies, and for them they pay out-of-pocket for all of their routine medical care. One respondent had brain surgery a few years ago – his policy costs him $30,000 a year with a 20% co-pay and $1-million cap – his initial surgery cost $75,000. We were surprised by the number of employed without health insurance. In several cases their employer offered a group plan, but did not contribute, the entire cost of insurance came out of the employees pay check -- $800 to $1,000/month.

Another finding that differed from the other markets was the number of respondents that got their primary care through physician assistants. They were all very pleased at the level of care they provided, and the amount of time that was spent in understanding their individual health concerns. They saw this in stark contrast to the treatment they had experienced from physicians that would spend at most 15-minutes with them. The physician assistants would ask question, let them ask questions, spend a great deal of time going over treatment options, even breaking out the books to show them exactly what they were talking about.

Drug advertising took a beating – “Drug advertising makes us think that taking a pill will cure everything.” They wondered if drug advertisings only purpose was to drive demand and increase sales. An example they came back to regularly was the new drug for restless leg syndrome – “what is this”, “never herd of this condition”, “sometimes my leg falls asleep do I need a drug?” They saw little good in advertising, though one respondent thought that it might provide information that he then could discuss with his doctor. Do they support the idea of regulating or banning ads – yes and no – some support an outright ban others do not.

Forget about it as a right, Iowans saw health care as an essential service such as the fire dept. – something everyone contributes to so it is there when needed. They think they can expect little support from Washington -- “Politicians know that Americans are complacent we just like to complain” – as a result they feel there is nothing to persuade politicians to take a stand against the special interest.

They firmly believed that there is enough money in the current health care system to fix the problem but cost and allocation of resources have to be addressed. They see a two tiered system, one in which the governments primary role is the control of prices for products and services and insuring that all have access to the system, they also feel their could be a private element – but the biggest issue they want addressed is cost.

Stafford , TX Day 2

Consumers are perplexed by our discussion of evidence based medicine – not because they don’t understand it, they assume that is the way medicine should be practiced. They think that the best docs, the right doc for them , not necessarily their current physician, would practice medicine in this manner. The idea that a doctor would base their decisions on what has proven to be effective, explain their various therapeutic options, and include them in the decision process – ask their opinions and weigh these needs is ideal,

Consumers have real reservations about getting the newest drug. They want a common sense approach. They would prefer to be prescribed a drug that has a history and has proven to be effective and safe. Overall, there is a sense that the medical community is to willing to push the newest innovation “Sounds like drug companies are just pushing the newest drugs…seems to me that they just want you to keep on taking medicine.”

Cost continued to be the key issue. Costs were seen as out of control --, $800 for blood work, $1,200 10-minute EKG, high cost of prescription drugs, Greed ascribed as a reason by some. Too most it seemed that everyone was trying to make money – the system seemed designed to run up cost. No one is seen as managing the underlying cost rather they simply manage the profits. When costs get out of control the system was not seen as addressing that issue, rather providers, insurance companies, and government simply turn to consumers for more money,

These consumers agreed that a fundamental change is needed. No one should be shut out of the health system because of ability to pay and neither should families be driven to financial ruin because of one illness or injury. They strongly support that there should be a basic level of care extended to all Americans. The notion of a socialized system is strongly rejected. What these consumers are looking for is a distinctly American system. They believe health care should not be free, but the costs should be reasonable. Healthcare is seen as a right, not quite at the level of free speech, but it should be something every American should have access to.

On to Iowa.

Road Stop -- Stafford Texas

We finished our first night in Stafford,TX, one more to go. The surprising thing is how similar the CT groups were to what we heard last night. As in CT the biggest issue to most was cost. This is not simply the cost of their co-pays or insurance contribution but the belief that costs are totally out of control. Some new experiences came to light last night -- medical tests gone wild. Many reported being referred for elaborate blood work-ups, CAT-scans and the like for seemingly mild maladies. One guy recounted his journey through 3 specialists 2 scans and a final bill of $8,000 and, in the end he was fine.

The contributors to runaway cost once again were identified as hospitals, pharma, and physicians, The perception was once they get hold of you the industry often tries to run up the cost.

Personal experience with their PCP's was varied. One or two had physicians that were very attentive, asked questions, listened, and explained the treatment options. The norm how ever was the 15-minute visit, a glance at the chart, a couple of questions, maybe a prescription and the patient was on their way.

The discussion of evidence based medicine bore mixed results. Most agree that they do not necessarily want the newest drug, but one that is proven effective and safe. There was a belief that doctors prescribed the latest drug being pushed by the drug industry. Some believe that the newest drugs are the best – why else would they be introduced – others thought that often the newest drugs are not well understood by practitioners and may have problems that are yet to be uncovered.

Respondents felt that Pharmaceutical companies push drugs with advertising to foster demand – "we see it advertised then we ask doctor and they sell more ... some doctors inclined to prescribe a drug simply because you asked for it." "Doctor gave me diabetes med I saw advertised – made my head spin – went back to old medicine." Advertising was also seen to increases which can be good and bad. Some respondents wondered how they would even know of new drugs if it wasn't for advertising. The bad thing "pushes drugs for the companies pushes drugs we don’t need."

More to come from Texas.

Health in the Heartland

Over the next several days this blog will be fleshed out regarding our observations of the experiences, concerns, and hopes of Americans in the heartland regarding our healthcare system. We will be speaking with dozens of citizens and sharing our perceptions with you.

The tour started in Suburban NY. We spoke with 40 men and women and all shared a common experience and belief -- the healthcare system in its current form is not working. The primary reason: costs are out of control. There is no single culprit. A lot of institutions share the blame . The greatest culprits in the eyes of these Americans were the drug companies and the government -- aka politicians. Doctors and hospitals also came under the gun but not nearly to the degree as Pharma and politicians.

Where are the costs? All over. The most visible culprit was drug companies. Consumers were enraged that U.S. Pharmaceutical companies sell their products in other countries at a fraction of the price that they do here -- they rightly wonder how this can be. If the health systems in other countries are able to negotiate favorable prices why can't the U.S. do the same? The answer for most was the politicians. Consumers know that Pharma is a huge lobby, employing hundreds-of-thousands, and are major contributors to all of the legislators -- in short they believe the politicians are in the pocket of the drug industry.

Consumers firmly believe that drug advertising drives costs up, though they are unsure of the mechanism. Some speculate that cost are high simply to pay for the advertising, others correctly identify the problem -- classic push-pull marketing. Push the new drugs out to docs with detailing, pull the inventory of new drugs through the system by fostering demand and perceived need with consumers -- the end result -- increase sales of the newest, and usually most expensive, drugs driving costs up and pumping profits into Pharma. Consumers object on all fronts. They object to the life-style advertising adopted by most drug marketers selling drugs like they were soft-drinks. They object to the vague symptoms featured in many -- who doesn't this drug apply to. They object to the end result - an over prescribed society. Mostly they object to the cost burden it places on society for the benefit of a few companies. Most would gladly support a regulation of drug advertising, possibly its prohibition. Why, they ask, are these companies spending money advertising products a consumer can not buy directly -- drug advice should come from physicians not a 30 second spot.

The next stops on the tour will take us through Texas and Iowa. Much more on the opinions from the heartland to follow.